As the summer arrives, Dr. Healy provides a further update on Zika virus, travel to affected areas, and risk and prevention.

Q: What are the important differences we now know about Zika that we didn’t know early on?

A: Early on there was an association of cecum and microcephaly, which isa condition in which the newborn head is small, in this case because the brain has not developed normally. The evidence supporting this association has strengthened since the time of the original concern. The knowledge regarding the mechanism of microcephaly in affected babies has increased. But, there are still many important things that we have yet to define.

What we do know…

• Pregnant women can be infected with Zika virus.

• The primary way that pregnant women get Zika virus is through the bite of an infected mosquito.

• Zika virus can be spread by a man to his sex partners.

• A pregnant woman can pass Zika virus to her fetus.

• Zika virus can be passed from a pregnant woman to her fetus during pregnancy or at delivery.

In moms who are infected we don’t know…

• How the virus will affect her or her pregnancy.

• How likely it is that Zika will pass to her fetus.

• If the fetus is infected, if it will develop birth defects.

• In babies without microcephaly, what is the impact of an in utero infection, if any?

• We don’t know when in pregnancy the infection might cause harm to the fetus.

• If sexual transmission of Zika virus poses a different risk of birth defects than mosquito-borne transmission.

Q: Are we in a worse situation now than earlier this year? Will it be worse because of the summer?

A: I do not believe we are in a worse situation now, because there is more knowledge about the virus and the ways it can be transmitted. As for the summer, it depends on the specific area you are speaking about. Any location in which mosquitoes that are capable of transmitting Zika virus are more common and people are more likely to be exposed to them, would be a concern. But, remember, the mosquitoes need to have the virus in order to infect people with it. Currently, this is not the case in United States.

Q: Is there a real chance that Zika might come to Massachusetts?

A: In order for this to happen, there would have to be the specific mosquitoes that are capable of transmitting the virus and people with the virus that they are able to bite. Currently, neither of these are believed to be present.

Q: Are there states in the country that people should stay away from?

A: Currently, the only cases that have been diagnosed in the continental U.S. have occurred either in travelers returning from at-risk areas or via sexual transmission. There is also a single case of a needle stick in a lab worker. There are no reported cases of people being infected from a mosquito bite in the continental U.S. Nevertheless, the type of mosquito that is capable of transmitting the virus is known to be present in the Gulf Coast states. Remember, however, that in order for the mosquito to transmit the virus, it must have the virus. This happens when the mosquito bites an infected person.

Q: Are we any closer to a vaccine?

A: It appears that we are still years away from a vaccine. Therefore, prevention through other techniques is recommended at this time.

Q: What about sex?

A: Barrier forms of contraception should be used between couples in which at least one of the individuals has traveled to a Zika-affected area. Recommendations are constantly being updated.

Q: The focus seems to be on microcephaly, but are there other problems associated with Zika?

A: In addition to microcephaly, other problems have been detected among fetuses and infants infected with Zika virus before birth, such as eye defects, hearing loss, and impaired growth. Although Zika virus is a cause of microcephaly and other severe fetal brain defects, and has been linked with these other problems in infants, there is more to learn. Researchers are collecting data to better understand the extent of Zika virus’ impact on mothers and their children.

Q: What about future pregnancies?

A: Based on the available evidence, we believe that Zika virus infection ina woman who is not pregnant would not pose a risk for birth defects in future pregnancies after the virus has cleared from her blood. From what we know about similar infections, once a person has been infected with Zika virus, he or she is likely to be protected from a future Zika infection.

Q: What about travel for women who are pregnant to the Olympics this summer or other areas where Zika is present?

A: I want to be clear, if you are pregnant or thinking about getting pregnant, you should not travel to a Zika-affected area. How do you know if a certain destination is a Zika-affected area? The CDC has an excellent website identifying these areas and it is updated regularly.

If for some reason you find yourself in a Zika-affected area, you should be using an insect repellent containing DEET, keeping as much skin covered by clothing as possible, and staying in areas with air conditioning and screens. Avoid stagnant water or other environments where mosquitoes are more likely to be found in. This recommendation applies to any person traveling to a Zika virus affected area.

Q: What about travel for women who are trying to get pregnant?

A: If you are trying to get pregnant, then you should not travel to a Zika-affected area. This warning applies to both men and women, as Zika has been found in semen and can remain in semen for weeks if not months after an infection. It is not simply that conception should not occur in a Zika virus affected area, but that there is concern about conception occurring in anyone who has the virus present either in his/her bloodstream or other bodily fluids.

The Centers for Disease Control and Prevention (CDC) say no woman should die of cervical cancer, and that the most important thing they can do to help prevent cervical cancer is to get screened regularly starting at age 21.